ESL Institute & APSU Undergraduate Application for Admission

This application should be used by international students wishing to apply for:

Full-time ESL admission only, or

Full-time ESL and APSU undergraduate admission

Students who are not studying under an F-1 student visa should use this application form.

A new student and express mail payment of $115 is required at time of application for ESL admission only. For ESL and APSU undergraduate admission, the payment is $140. If not used, the express mail payment will be applied towards tuition.

If a printable application is preferred, please contact the ESL Institute at esl@apsu.edu.

IMPORTANT NOTE: Before you begin this online application form, please review the questions and gather all required information. The form cannot be saved if only partially completed. You will be able to print a copy of the entire form for your records when you have finished.

1. Name

Family/Last Name: *

Given/First Name: *

Middle Name:

Previous Name(s)/Maiden Name:

Preferred Name:

2. Permanent Address (in home country)

This must be your permanent address in your home country. If you are in the United States now, do not enter your U.S. address. You will enter your U.S. address in #9.

Street 1: *

(Street number and name)

Street 2:

(Apartment, suite or P.O. box number if applicable)

City: *

State/Province/Territory: *

Zip/Postal Code: *

Country: *

Home Phone: *

(Country code, area code and number)

Mobile Phone:

(Country code, area code, number)

Fax (if available):

(Country code, area code, number)

3. Email Address

Email: *

Please provide a complete email address which you check regularly. Do not enter an agent, family relative or friend email. This must be student's email. Other email address can be added in questions 10 and 12.

4. Date of Birth

Country of Birth: *

5. Gender

male

female

6. Citizenship

Country of citizenship: *

7. Are you Hispanic/Latino?

yes

no

8. Select one or more race(s)

White

Black or African American

Asian

American Indian

Alaska Native

Native Hawaiian or other Pacific Islander

9. Do you need an I-20 Form from the ESL Institute at APSU?

The I-20 Form is used to apply for an F-1 international student visa. The ESL Institute will only provide I-20 forms to students who apply for the intensive English program (full-time study).

Yes, I am now outside the U.S.

Yes, I am changing my visa to F-1

No, I am studying at another institution in the U.S. and will transfer.

No, I have another type of visa.

Name of institution (current or previous place of study in the U.S.): *

Dates of attendance (at current or previous institution in the U.S.): *

Your current U.S. address (street number and name, Apt #): *

Your current U.S. address (city, state, zip code): *

Your current U.S. phone number:

(area code and number: xxx-xxx-xxxx)

What type of visa do you have now?:

B-1 (business)

B-2 (tourist)

J-1 (exchange visitor)

J-1 (au pair)

Other...

What is the expiration date of your visa?: *

10. Do you have a local sponsor or relative in the Clarksville/Nashville area?

yes

no

Emergency contact/local sponsor information

If you have a relative or sponsor living in the Clarksville/Nashville area, please provide their contact information below. We will work with them to ensure they receive information about your registration and classes in order to assist you with your arrival and transition to the ESL Institute.

First and Last Name:

Relationship to student:

Address:

Street, P.O. Box and/or Apt #

City:

State/Province/Territory:

Country:

Zip/Postal Code:

Phone:

Format: (xxx) xxx-xxxx

Email:

Fax (if available):

11. Are you under (less than) 18 years old?

yes

no, I am more than 18 years old

Parent/guardian information (required for students under 18)

Name:

Phone:

(Country code, area code, number)

Relationship to student:

Address:

Street/PO Box/Apt #

City:

State/Province/Territory:

Country:

Zip/Postal Code:

12. Agent/Education Consultant

Are you using an agent or educational consultant?: *

yes

no

Name of Agent:

Name of Agency/Company:

Email for Agent:

13. Academic History

Please do not abbreviate. An official transcript must be sent to the ESL Institute and/or the Office of Admissions.

Name of high school: *

High school graduation date: *

(month and year)

City and State/Province/Territory of high school: *

Name under which transcript will be issued: *

Do you have a GED (if you did not graduate from high school?):

yes

no

If "yes" to the above question, enter the date GED was received:

(month and year)

Name under which GED scores will be issued:

14. Colleges and universities previously attended

Please DO NOT abbreviate. List ALL colleges and universities previously attended, including APSU (main campus and Fort Campbell), and language programs in chronological sequence.

Name of institution:

City:

State:

Degree Earned:

Dates Attended: (month and year)

Name under which transcript will be issued:

How many other institutions have you attended?: *

Institution 2

Name of institution:

City:

State:

Degree Earned:

Dates Attended:

Name under which transcript will be issued:

Institution 3

Name of institution:

City:

State:

Degree Earned:

Dates Attended:

Name under which transcript will be issued:

Institution 4

Name of institution:

City:

State:

Degree Earned:

Dates Attended:

Name under which transcript will be issued:

Institution 5

Name of institution:

City:

State:

Degree Earned:

Dates Attended:

Name under which transcript will be issued:

15. When will you start ESL classes?

16. Entry level

Please choose your entry level: *

First-time student

Transfer student; first time at APSU

17. Housing preference

Where will you live?: *

I will apply to live on-campus in student housing (dormitories or apartments).

I will live off-campus and will find my own housing.

18. When do you plan to begin taking undergraduate courses at Austin Peay?

Do you need a conditional admission letter for undergraduate (BA) study at APSU after ESL study?: *

yes

no

18b. Undergraduate Major

Please select your intended major and major code from the drop down list; include a concentration code if applicable.

Name of major:

Concentration code (if applicable):

18c. Selective Service registration

Consistent with the federal Military Service Selective Service Act, Tennessee law requires all male applicants to be registered with the Selected Service (or certify exemption from the registration requirement) prior to enrolling in state colleges and universities. You must certify compliance in section 1 below or indicate the basis upon which you claim exemption in section 2 below. For more information, or to register online, please go to www.sss.gov.

1. I certify that I am registered with the Selective Service System as required by law.: *

Yes

No

2. I certify that I am not required to be registered with the Selective Service System because:: *

I am not a U.S. citizen.

I am female.

I am younger than 18 years of age.

I am a current member of the armed forces on active duty.

I was born before 1960.

I am an exempt Resident Alien.

Other...

19. Applicant acknowledgement

If you are accepted as a student at APSU, you will be required to take certain performance tests during your academic career. It is a requirement of admissions that you agree to take an tests deemed necessary by the University. The purpose of this requirement is to comply with the Tennessee Legislature's expressed intent that institutions regularly evaluate and improve instruction at all levels. If you are under 21 years of age and are required to complete academic assessment testing, your scores on these tests and course placement may be reported to your high school for research purposes. Any test scores will be treated confidentially as required by law.

By submission of this application, I certify that the information supplied on this form is complete and true. I understand that falsifying information may lead to disciplinary action and/or dismissal from the University. If accepted for admission, I agree to abide by all APSU rules and regulations as printed in the Code of Student Conduct, ESL Institute Student Handbook, Undergraduate Bulletin and other University publications.

20. How did you learn about APSU and the ESL Institute?: *

From a current ESL student

From a friend or family member

From a poster or printed brochure

From the APSU website

From a general internet search

From an online Fort Campbell Courier ad

From an online international student directory (such as StudyUSA, Intensive English USA, etc.)

Other...

Name of current student:

Full name of current student: Given and Family names

Information for students with disability

If you have a learning or physical disability and want information on types of services and support that are available, please contact the Office of Disability Services at 931-221-6230 voice, 931-221-6278 tty. It is recommended that students who may benefit from these services notify the ESL Institute so that appropriate accommodations can be arranged.

Note: You must also press the "Submit" button in order for your application to be submitted.

Austin Peay State University (APSU) does not discriminate against students, employees, or applicants for admission or employment on the basis of race, color, religion, creed, national origin, sex (including pregnancy), sexual orientation, gender identity/expression, disability, age, status as a protected veteran, genetic information, or any other legally protected class with respect to all employment, programs and activities sponsored by APSU. Inquiries or complaints regarding the non-discrimination policies, including Title IX complaints, should be directed to the Director of Equal Opportunity and Affirmative Action and Title IX Coordinator, Sheila Bryant, 601 College Street, Browning Building/Rm 151, Clarksville, TN 37044, bryantsm@apsu.edu, 931-221-7178 or EEO Compliance Officer and Investigator, Steven Grudzinski, College Street, Browning Building/Rm 6A, Clarksville, TN 37044, grudzinskis@apsu.edu, 931-221-7160. Title IX complaints may also be directed to the Deputy Title IX Coordinator, Greg Singleton Associate Vice President and Dean of Students, 601 College Street, Morgan University Center/Rm 206D, Clarksville, TN 37044, singletong@apsu.edu931-221-7005. | Non-Discrimination Policy